The Lucy Thermal Emission Spectrometer (L'TES) Instrument.

The Lucy Thermal Emission Spectrometer (L'TES) will provide remote measurements of the thermophysical properties of the Trojan asteroids studied by the Lucy mission. L'TES is build-to-print hardware copy of the OTES instrument flown on OSIRIS-REx. It is a Fourier Transform spectrometer covering the spectral range 5.71-100 µm (1750-100 cm-1) with spectral sampling intervals of 8.64, 17.3, and 34.6 cm-1 and a 7.3-mrad field of view. The L'TES telescope is a 15.2-cm diameter Cassegrain telescope that feeds a flat-plate Michelson moving mirror mounted on a linear voice-coil motor assembly to a single uncooled deuterated l-alanine doped triglycine sulfate (DLATGS) pyroelectric detector. A significant firmware change from OTES is the ability to acquire interferograms of different length and spectral resolution with acquisition times of 0.5, 1, and 2 seconds. A single ∼0.851 µm laser diode is used in a metrology interferometer to provide precise moving mirror control and IR sampling at 772 Hz. The beamsplitter is a 38-mm diameter, 1-mm thick chemical vapor deposited diamond with an antireflection microstructure to minimize surface reflection. An internal calibration cone blackbody target, together with observations of space, provides radiometric calibration. The radiometric precision in a single spectrum is ≤2.2 × 10-8 W cm-2 sr-1 /cm-1 between 300 and 1350 cm-1. The absolute temperature error is <2 K for scene temperatures >75 K. The overall L'TES envelope size is 37.6 × 29.0 × 30.4 cm, and the mass is 6.47 kg. The power consumption is 12.6 W average. L'TES was developed by Arizona State University with AZ Space Technologies developing the electronics. L'TES was integrated, tested, and radiometrically calibrated on the Arizona State University campus in Tempe, AZ. Initial data from space have verified the instrument's radiometric and spatial performance.

Bronchiectasis. A late feature of severe rheumatoid arthritis.

Bronchiectasis as a feature of rheumatoid arthritis is considered rare and, in most series, has preceded rheumatoid arthritis. We identified 23 patients with rheumatoid arthritis and bronchiectasis at the Brigham and Women's Hospital followed between 1984 and 1991, 18 of whom had arthritis preceding lung disease. The 18 patients with rheumatoid arthritis and subsequent bronchiectasis had a mean age of 63.8 years. Fourteen were women and 4 were men, with a mean arthritis duration of 24.7 years before bronchiectasis developed. Most patients had seropositive and nodular disease. All but 1 had advanced radiographic changes of rheumatoid arthritis, and many had received joint replacement surgery. In addition to standard treatment regimens, 17 patients had received corticosteroids. Productive cough, hemoptysis, and dyspnea were the most common respiratory symptoms and were present for an average of 4.3 years prior to bronchiectasis diagnosis. The most common radiographic abnormalities were bibasilar diffusely increased interstitial markings and focal infiltrates, although nodules, bullae, cysts, and air-fluid levels were found. Common pulmonary-function abnormalities were obstructive and/or restrictive abnormalities. Three patients died of complications relating to bronchiectasis. Five patients with rheumatoid arthritis had antecedent bronchiectasis. Compared with patients with rheumatoid arthritis and subsequent bronchiectasis, those with antecedent lung disease had milder arthritis (stage I or II radiographic changes, p < 0.001), a lower frequency of rheumatoid nodules (p < 0.05) and a lower comorbidity score (5.8 versus 9.4, p < 0.01). They also had received fewer disease-modifying agents for the treatment of their rheumatoid arthritis. Bronchiectasis can be a feature of rheumatoid arthritis and is often found in patients with severe, long-standing nodular disease. Recurrent pulmonary infections and respiratory failure occur and may be fatal.

Immunoblastic lymphoma of donor origin in the allograft after lung transplantation.

Posttransplant lymphoproliferative disorders (PTLD) are EBV-associated lymphoid neoplasms that are caused by the uncontrolled growth of EBV-infected B lymphocytes. The clinical presentation of PTLD can range from benign polygonal lymphoproliferative disorders to aggressive monoclonal immunoblastic lymphomas. In this report, we describe a seronegative lung transplant recipient who developed an immunoblastic lymphoma 4 months after lung transplantation from a seropositive donor. The neoplastic cells expressed B lymphocyte markers (CD19+, CD20+, sIgM+, kappa+) as well as the EBV antigen EBNA-2. A cell line with similar cytologic features spontaneously grew from in vitro cultures of the patient's peripheral blood mononuclear cells. The cell line and the lymphoma were EBV+, expressed a similar spectrum of B cell surface proteins, and had the donor's HLA haplotype. Analysis of immunoglobulin gene rearrangements and viral terminal repeat sequences revealed that the cell line and the tumor represented distinct B cell clones. Cultured peripheral blood mononuclear cells were restimulated in vitro with the EBV transformed cell line and tested for cytolytic activity. The host T cells demonstrated high levels of cytolytic activity against the tumor cell line that was abrogated by the addition of a anti-monomorphic HLA class I monoclonal antibody (mAb) (W6/32). These studies indicate that cells of donor origin can persist in the transplanted organ and may lead to an EBV-associated posttransplant lymphoma.

Small cell lung cancer. Case report.

The selection of appropriate chemotherapeutic and/or radiation therapy for small cell lung cancer should be done after careful diagnosis and staging workup. A patient with small cell lung cancer is presented and explanation given for each step in diagnosis and staging.

Clearance of Pneumocystis carinii cysts in acute P carinii pneumonia: assessment by serial sputum induction.

STUDY OBJECTIVES: To determine the feasibility of repeat sputum induction in acute Pneumocystis carinii pneumonia (PCP) and to define the rate of clearance of P carinii cysts from the respiratory tract of HIV-seropositive patients with acute PCP. DESIGN: Prospective cohort evaluation. SETTING: University medical center. PARTICIPANTS: Twenty-four HIV-seropositive subjects with acute PCP. MEASUREMENTS: Sputum induction for P carinii 2, 3, 4, and 6 weeks after initial diagnosis, and follow-up for 1 year. RESULTS: Eighty-eight percent of subjects had residual cysts at 2 weeks, 76% at 3 weeks, 29% at 4 weeks, and 24% at 6 weeks postdiagnosis. A prior AIDS-defining illness (p = 0.033) or prior PCP (p = 0.004) predicted relapse within 6 months, but persistent cysts at 3 weeks did not; 8 of 16 sputum-positive subjects and 1 of 5 sputum-negative subjects experienced a relapse within 6 months (p = 0.34). Secondary prophylaxis with trimethoprim-sulfamethoxazole was associated with a reduced risk of relapse. CONCLUSIONS: Serial sputum induction coupled with direct fluorescent antibody staining is a feasible, noninvasive method of respiratory tract surveillance for the eradication of P carinii during and after acute PCP. Three-quarters of HIV-seropositive patients with acute PCP have persistent cysts in their lungs at the end of antimicrobial treatment, despite clinical recuperation, but only one quarter have residual cysts 6 weeks postdiagnosis. A prior AIDS-defining illness and prior PCP are positively associated, and subsequent trimethoprim-sulfamethoxazole prophylaxis is negatively associated, with relapse within 6 months, while persistent organisms at 3 weeks do not appear to be a significant predictor of relapse risk.

Vasculitis with recurrent pulmonary hemorrhage in a long-term survivor after autologous bone marrow transplantation.

We report an unusual vasculitic syndrome in a long-term survivor of autologous bone marrow transplant. Clinical and pathologic studies revealed a cutaneous and pulmonary leukocytoclastic vasculitis complicated by recurrent pulmonary hemorrhage. Serologic studies revealed an elevated anti-neutrophil cytoplasmic antibody titer. The vasculitis has been successfully controlled with prednisone, cyclophosphamide, and trimethoprim/sulfamethoxazole.

Surgical complications related to insertion of penile prostheses with emphasis on infection and cost.

We initiated a prospective study of penile prosthesis implant surgery to evaluate risk factors for infection and other complications. Twenty-one patients admitted for surgery or related complications were evaluated over a seven-month period. The two types of penile prostheses implanted were (1) inflatable and (2) semi-rigid. Nine of 21 patients (43%) developed postoperative complications. Although cephapirin and gentamicin were given prophylactically, four of nine patients had four wound infections and one case of pneumonia. One case of Bacteroides fragilis bacteremia was due to stool incontinency during surgery. In two of the wound infections, removal and reinsertion of the prosthesis was necessary. Other complications included hypotension during surgery, prosthesis malfunction and malposition, and urethral tears. There were no significant associations between infection and age, length of surgery, or type of prosthesis used. These complications contributed to prolonged hospital stay and readmission (87 extra days for the infected patients at a cost of $44,000). Antibiotic costs to treat the infections totaled $1,900. Prospective evaluation by infection control practitioners of various elective surgeries can be useful in quantitating the complication rate and targeting patients at risk, with the goal of minimizing hospital costs.

Transvesical cesarean following bowel and urinary tract reconstructive surgery.

Intentional transvesical cesarean was done for delivery in a woman born with an imperforate anus, ectopic intravaginal urethra, and vaginal and urethral strictures. She had undergone multiple reconstructive procedures that left her bladder completely covering the anterior uterine surface. The rest of the uterus, including the fundus and the broad ligaments, was obscured by multiple bowel adhesions. Cesarean delivery was necessary because of pelvic bone and soft-tissue deformity. Anterior and posterior vertical cystotomies resulted in exposure of the anterior uterine wall, and the fetus was delivered through a vertical uterine incision. The woman recovered and 6 months later has no genitourinary complaints.

Postmenopausal ureteral endometriosis with atypical adenomatous hyperplasia following hysterectomy, bilateral oophorectomy, and long-term estrogen therapy.

Endometriosis of the ureter is rare. The authors describe a case of ureteral endometriosis presumed on clinical and radiologic grounds to be a primary ureteral malignancy. The unique feature of the present case is the development, after long-term estrogen therapy, of postmenopausal ureteral endometriosis with extensive atypical adenomatous hyperplasia. The present case demonstrates that reactivation of endometriosis and the development of atypical hyperplasia may occur after menopause with prolonged estrogen therapy.

Single-lung transplantation in situs inversus.

Situs inversus totalis is a rare anatomic condition characterized by the mirror-imaged arrangement of asymmetric thoracic and abdominal organs. Although associated cardiopulmonary disease is uncommon, end-stage lung disease can develop in patients with situs inversus, necessitating transplantation. In this report, we describe a 30-year-old patient with situs inversus totalis and end-stage pulmonary hypertension who underwent successful orthotopic left lung transplantation.

Urolume stent placement for the treatment of postbrachytherapy bladder outlet obstruction.

OBJECTIVES: Transurethral resection (TURP) or incision of the prostate is generally not effective for treating bladder outlet obstruction after transperineal brachytherapy for prostate cancer. Furthermore, TURP could compromise full-dose effective radiation delivery to the prostate. We analyzed the efficacy of the UroLume stent in treating the urinary outflow obstruction in such patients. METHODS: Five patients who had undergone brachytherapy (3 with (192)Ir high-dose radiation and 2 with (125)I) subsequently developed one or more episodes of urinary retention 2 weeks to 4 years after treatment. The patients failed or could not tolerate alpha-blockers or clean intermittent catheterization. Three patients subsequently underwent urethral dilation/optical internal urethrotomy for strictures, and 1 patient underwent suprapubic tube placement. Following the failure of these interventions, each of these patients had a UroLume stent placement. A single UroLume stent (2 cm in 3 patients and 2.5 cm in 2 patients) was placed under local/spinal anesthesia. RESULTS: All patients were able to void spontaneously immediately after stent placement. Of the patients with previous urethral strictures, 1 remained continent and 1 had persistent incontinence. Neither of the patients with early postbrachytherapy retention developed incontinence after stent placement. The main complaints following stent placement were referred pain to the head of the penis and dysuria. Stent-related symptoms necessitated stent removal in 2 of 5 patients, 4 to 6 weeks after placement. CONCLUSIONS: The UroLume stent can be used as an alternative form of therapy for managing postbrachytherapy bladder outlet obstruction. The treatment is easily reversible by removing the stent when obstruction resolves.

Routine frozen section of pelvic lymph node specimens prior to radical retropubic prostatectomy is unnecessary in patients with prostate specific antigen.

Our prospective study was designed to evaluate the routine use of frozen section of pelvic lymph node specimens prior to radical prostatectomy in patients with pre-biopsy prostate specific antigen (PSA) levels less than 20 ng/ml. Included in our study were 241 patients who had clinically localized disease on digital rectal examination, a negative preoperative metastatic work-up, and a pre-biopsy serum PSA of less than 20 ng/ml. If a palpable abnormality of pelvic lymph nodes was detected at the time of surgery, specimens were sent for frozen section analysis. Lymphatic specimens that were palpably normal were sent for permanent section only. Ten (4.1%) of the 241 patients had pelvic lymph node metastases demonstrated by permanent section. Of the patients with lymph node metastasis, 50% had Gleason scores of 8-10 on their needle biopsy specimens. None of these patients had frozen section analysis of their lymph nodes. Frozen section failed to detect lymph node metastasis in all cases analyzed. Routine frozen section analysis of pelvic lymphadenectomy specimens in patients with clinically localized prostate cancer, Gleason score 2-7 on the needle biopsy, and prebiopsy PSA of less than 20 ng/ml is unnecessary.

Evaluation of computerized tomography for staging of clinically localized adenocarcinoma of the prostate.

We conducted a retrospective review of 345 patients who underwent radical prostatectomy between 1991 and 1994 to assess the overall accuracy, sensitivity, and specificity of computerized tomography (CT) for detection of disease outside the prostate. In 139 patients who were eligible for study, the overall accuracy, sensitivity, and specificity were 51%, 79%, and 30%, respectively. For lymph node metastases only, the values were 89%, 7%, and 97%, respectively. For local extraprostatic extension, the values were 48%, 30%, and 83%, respectively. The overall positive predictive value of CT was 67% and the negative predictive value was 45%. CT has minimal to no utility in detecting extraprostatic disease in patients with clinically localized prostate cancer.

Trimethoprim-sulfamethoxazole and hypouricemia.

BACKGROUND: Hypouricemia has been reported in a substantial fraction of patients with AIDS and attributed to an HIV-related renal urate transport defect. We tested the alternative hypothesis that hypouricemia was associated with the administration of high-dose trimethoprim-sulfamethoxazole (TMP-SMX). METHODS: Sociodemographic, clinical, and repeated laboratory data on 45 hospitalized patients with Pneumocystis carinii pneumonia (PCP) with and without HIV infection, were abstracted by a blinded reviewer. The primary outcome of interest was the percent change in serum uric acid concentration from baseline to hospital day 5 +/- 1. RESULTS: Subjects who received TMP-SMX were older (mean age 44.8 vs. 37.0, p = 0.02), less likely to be HIV-seropositive (61% vs. 94%, p = 0.01), and more likely to have received glucocorticoid therapy (75% vs. 35%, p = 0.01) than those who received pentamidine, dapsone-trimethoprim, clindamycin-primaquine, sulfadiazine-pyramethamine, or a combination of these agents. The administration of TMP-SMX was associated with a 37% +/- 12% reduction in serum uric acid concentration, adjusting for the effects of age, sex, race, HIV antibody status, renal function, serum sodium, and the use of diuretics and glucocorticoids (p = 0.005). CONCLUSION: Among a diverse cohort of hospitalized patients with PCP, treatment with high-dose TMP-SMX was strongly associated with a reduction in serum uric acid concentration over time.

Urological management in the patient with acute spinal cord injury.

Understanding the neurophysiology of micturition has led to pharmacologic manipulation and improvement in rates of mortality and morbidity. Use of intermittent self-catheterization and the artificial urinary sphincter (AUS) has improved the "quality of life" of these patients. Implantation of various penile prostheses has improved sexual rehabilitation. Urinary diversion is the "last resort" surgery.

Neuropsychological symptoms in a cross-sectional sample of abstinent alcoholics.

This study examined the neuropsychological symptom reports of a cross-sectional sample of 205 abstinent alcoholics. Analysis indicated that early-abstinent alcoholics reported mild cognitive distress with a gradual course of observed recovery which eventually reached the normal range. The recovery process was essentially the same for both men and women. A nonsignificant increase in symptom reporting was found for subjects who were beyond the acute stage of detoxification, which is thought to reflect improved awareness of neuropsychological functioning. Symptoms of frustration were rated highest by alcoholics at all stages of abstinence.

Employee assistance programs: a worldwide perspective.

Once limited to U.S. corporations, employee assistance programs (EAPs) are now spreading around the world. The authors review global EAP trends and identify similarities and differences among EAPs in North America, Europe, Central and South America, the Asia-Pacific region, and the Caribbean. Through affiliations between international professional associations and services to multinational corporations, the EAP field is quietly creating globalized behavioral health services.